What is the recommended dose of triamcinolone acetonide (steroid shot) for an 18-year-old with a rash?

Recommended Dosage of Triamcinolone Acetonide for Rash in an 18-Year-Old

For an 18-year-old with a rash, triamcinolone acetonide can be administered at 10 mg/mL concentration, which may be diluted with sterile normal saline to 5 or 3.3 mg/mL depending on the type and severity of the rash. 1

Dosing Guidelines Based on Rash Type

For Inflammatory/Nodular Lesions:

• Triamcinolone acetonide 10 mg/mL for inflammatory follicular lesions 1
• May be diluted to 5 or 3.3 mg/mL with sterile normal saline for smaller or less severe lesions 1
• For adults, doses up to 10 mg for smaller areas and up to 40 mg for larger areas are typically sufficient 2

For Hypertrophic Scars or Keloids:

• Higher concentration (triamcinolone acetonide 40 mg/mL) may be used 1

Administration Technique

• Inject directly into the lesion using strict aseptic technique 2
• Ensure proper injection technique to avoid blood vessels 2
• For multiple lesions, single injections into several areas up to a total of 80 mg can be administered 2

Contraindications

• Do not inject at sites of active infections (impetigo, herpes) 1
• Avoid in patients with hypersensitivity to triamcinolone 1
• Use caution in patients with:
  • Active tuberculosis or systemic fungal infections 1
  • Extensive plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis 1
  • Uncontrolled diabetes, heart failure, or severe hypertension 1
  • Severe depression or psychosis 1

Expected Response

• Most inflammatory lesions flatten within 48 to 72 hours 1
• Efficacious for occasional or particularly stubborn lesions 1
• Not an effective strategy for patients with multiple widespread lesions 1

Potential Adverse Effects

• Local overdose can result in skin atrophy, pigmentary changes, and telangiectasias 1
• Other potential side effects include:
  • Hypertrichosis 1
  • Impaired wound healing 1
  • Contact allergic dermatitis (from preservative, benzyl alcohol) 1
  • Sterile abscess formation 1
  • Steroid-induced acne 1
  • Repeated injections may suppress the hypothalamic-pituitary-adrenal axis 1
  • Rare cases of anaphylaxis, angioedema, and urticaria 1

Alternative Treatments to Consider

• For widespread rashes, topical corticosteroids may be more appropriate:
  • Class I topical corticosteroid (clobetasol propionate, halobetasol propionate, betamethasone dipropionate) for body areas 1
  • Class V/VI corticosteroid (aclometasone, desonide, hydrocortisone 2.5%) for facial areas 1
• For pruritic rashes, oral antihistamines may be added (cetirizine/loratadine 10 mg daily or hydroxyzine 10-25 mg QID) 1

Clinical Pearls

• Shake the vial before use to ensure uniform suspension 2
• Inspect for clumping or granular appearance before withdrawal 2
• Inject without delay after withdrawal to prevent settling in the syringe 2
• Consider topical treatments for widespread rashes rather than multiple injections 3
• Percutaneous absorption of topical triamcinolone is generally minimal in patients with intact skin 4